To compare the stone-free rate and complications between horseshoe and normal kidneys.

Between December 1997 and June 2008, a total of 2401 patients with 2618 renal units underwent percutaneous nephrolithotomy (PCNL). During this period, we retrospectively reviewed the data of 46 patients with 50 (1.9%) renal units with horseshoe kidneys treated by PCNL. We compared the success and complication rate in horseshoe kidney and normal kidney.

Fifty PCNL were performed in the above-mentioned 46 patients with a mean age of 41.6 years. The average stone burden ranged from 100 to 4900 mm² (mean, 644 ± 135 mm²). The stones were located in the renal pelvis in 13 (26%), calices in 17 (34%), and in both in 11 kidneys (22%). A single tract was used in 42 kidneys (84%), and 2 tracts were created in the remaining 8 (16%). Major complications were seen in 8 PCNL procedures (16%). A detailed comparison between horseshoe and normal kidneys showed that stone burden, operation time, stone-free rates, and auxiliary procedure rates were similar. The only statistically significant difference was detected in the number of access, which is more in normal kidneys. Logistic regression analysis did not reveal that horseshoe kidney did not have any negative effect on success after PCNL.

Despite the anatomic abnormalities, PCNL is a safe and effective treatment option for calculi both in the horseshoe kidney and the normal kidney with the similar success and complications rates.